ENT

Question 1

What is the watershed area of the vascular supply to the nose?

Answer 1

Kiesselbach’s plexus

This is the area in the anterior part of the nasal septum where the branches of the labial, sphenopalatine, and ethmoidal arteries meet.

Question 2

How often are tracheostomies changed?

Answer 2

Children have a one-piece canula and it is changed weekly.

Adults have a stoma piece that is changed every two months and a canula that is changed weekly.

Question 3

Dysphonia (hoarseness) and palpable neck emphysema in a trauma patient suggest what diagnosis?

Answer 3

Laryngeal fracture

Question 4

Unilateral submandibular swelling can be caused by ____________-lithiasis.

Answer 4

sialo

Stones in the salivary ducts can be seen on POCUS or CT.

Question 5

When is cleft lip usually repaired?

Answer 5

10 weeks of life

Question 6

What are indications for urgent endoscopy to remove stuck objects in the throat?

Answer 6

Difficulty swallowing
Inability to swallow secretions
Respiratory distress

Question 7

Why is it important to identify and drain septal hematomas?

Answer 7

The cartilage of the nose (including the septum) is avascular. Its blood supply is provided by the perichondrium. Septal hematomas are usually hematomas underneath the perichondrium and above the cartilage. The hematoma can lead to ischemic necrosis of the septum.

Question 8

What percent of rhinosinusitis is caused by bacteria?

Answer 8

0.5 - 2.0 %

Question 9

What is the top rim of the ear called?

Answer 9

The helix

Question 10

What is the name of the little piece of tissue that sticks out of the meatus of the ear from the anterior rim of the ear?

Answer 10

The tragus

Question 11

For post-piercing infections, you need to cover for _____________.

Answer 11

Pseudomonas aeruginosa

Question 12

Review the management of suspected tracheoarterial fistula.

Answer 12

1) Overinflate the balloon to attempt tamponade
2) Secure airway with orotracheal intubation
3) Remove tracheostomy tube
4) Digitally compress artery with finger against sternum

Question 13

What two atomized medications can you give to refractory epistaxis?

Answer 13

Afrin and TXA

Question 14

If a person with a live insect in the ear has a lidocaine allergy, what else can you use to kill the insect?

Answer 14

Mineral oil

Question 15

Do not irrigate the ear if you are concerned that ___________________.

Answer 15

the ear drum might be perforated

Question 16

The part of the jaw that is anterior to the condyle is the ______________.

Answer 16

coronoid process

The coronoid process and condyle join together at the ramus. The ramus leads to the angle. The angle leads to the body and ultimately to the symphysis.

Question 17

Which bones of the face is least likely to fracture?

Answer 17

Frontal

Question 18

If you remove a foreign body from the ear canal and there are abrasions in the canal afterwards, be sure to __________________.

Answer 18

prescribe 2-3 days of ciprofloxacin otic drops at discharge

Question 19

Which types of LeFort fractures can affect the cerebrovasculature?

Answer 19

II, III, and IV

Question 20

Review the zones of the neck.

Answer 20

Zone I: clavicles to cricoid cartilage
Zone II: cricoid cartilage to mandible
Zone III: mandible to skull base

Question 21

The most common serious complication of Ludwig’s angina is what?

Answer 21

Sudden asphyxiation from edema

Question 22

Trismus, fever, nuchal rigidity, muffled voice, and pain with neck extension suggest what?

Answer 22

Retropharyngeal abscess (in the prevertebral fascia)

Question 23

How does posterior epistaxis present?

Answer 23

Heavy bilateral bleeding from both nares and posterior bleeding noted

Question 24

Rhino rockets should be coated in ____________ in treating patients on anticoagulation.

Answer 24

TXA

Question 25

Rhino rockets should be removed in _______ hours.

Answer 25

72

Question 26

What are three complications of Ludwig angina?

Answer 26

IJ thrombosis, mediastinitis, and meningitis

Question 27

Posterior epistaxis most commonly arise from bleeding in which vessel?

Answer 27

Sphenopalatine artery

Question 28

The lateral neck radiograph for evaluating for retropharyngeal abscess should be done how?

Answer 28

With the neck in extension (tilting head back) at end inspiration Flexing the neck expands the retropharyngeal space and leads to higher false positives. Likewise, exhaling also expands the space.

Question 29

Why are children younger than 4 more prone to retropharyngeal abscess?

Answer 29

There are retropharyngeal lymph nodes that involute after age 4. They are prone to infection.

Question 30

In the Rinne test, air conduction is supposed to be _________ than bone conduction.

Answer 30

better You first have the tuning fork on the mastoid. When they can't hear it any more put the fork next to the auditory meatus. If they can't hear it, it suggests conductive hearing loss.

Question 31

What are the indications for draining an auricular hematoma?

Answer 31

Recent (less than 7 days) bleed that deforms the pinna

Question 32

After draining an auricular hematoma, always _______________.

Answer 32

do a pressure dressing to prevent reaccumulation

Question 33

What is the most common pathogen that causes bacterial tracheitis?

Answer 33

S. aureus

Question 34

True or false: purulent nasal drainage is a sign of bacterial rhinosinusitis and warrants urgent antibiotics.

Answer 34

False Viral rhinosinusitis can also cause purulent drainage.

Question 35

What is the duct called that carries saliva to the area near the frenulum?

Answer 35

Wharton duct

Question 36

What pressure should ETT tubes be set at?

Answer 36

20-30 cm H2O

Question 37

Expiratory stridor in a person with a recent history of prolonged intubation is likely ______________.

Answer 37

acquired tracheomalacia

Question 38

The carotid sheath lies _____ posterolateral to the tonsil.

Answer 38

2.5 cm

Question 39

What is the sensitivity of lateral neck X-ray for epiglottitis?

Answer 39

88%

Question 40

True or false: nasal septal hematoma should be drained with needle aspiration.

Answer 40

False Needle aspiration cannot evacuate clots. I&D is preferred.

Question 41

What technique is needed for a lateral neck xr for r/o RPA?

Answer 41

Extension and inspiration Flexing forward and exhaling cause the pharynx to relax which makes it difficult to see abnormal soft tissue swellings.

Question 42

Criteria for RPA on XR?

Answer 42

7 mm at C2, 14 mm at C6

Question 43

What does bacterial tracheitis show on lateral x-ray?

Answer 43

Irregular densities on the trachea

Question 44

Epiglottitis with no difficulty swallowing is likely what etiology?

Answer 44

Bacterial tracheitis

Question 45

With nasal bone fracture, what three things can be emergencies that require reduction and/or other manipulation?

Answer 45

CSF leak (suggesting occult basilar skull fracture) Uncontrolled epistaxis Occlusion of one or both nares

Question 46

What is a tripod fracture and why is it important?

Answer 46

A tripod fracture occurs when the supports to the lateral cheekbone (the zygoma, the maxilla, and the lateral orbit) are all fractured. This is important because they are operative. They need stabilization or the face will be asymmetric.

Question 47

Which bone is fractured in CSF rhinorrhea?

Answer 47

Ethmoid

Question 48

What is the treatment for simple and complex aphthous stomatitis?

Answer 48

Simple (short course, few lesions): topical steroids Complex (long course, recurrent, many lesions): PO steroids

Question 49

True or false: the corner of the jaw is the mandibular ramus.

Answer 49

False The corner of the jaw is the mandibular angle. The ramus is superior to the angle, beneath the condyle (posterior) and cornoid (anterior).

Question 50

Which facial fractures are associated with infraorbital anesthesia?

Answer 50

Inferior orbital wall

Question 51

True or false: if you see active bleeding in the nose then cautery is the first-line treatment.

Answer 51

False Oxymetazoline is always first line.

Question 52

What is a cholesteatoma?

Answer 52

A mass of keratinized epithelium in the middle ear

Question 53

What is the narrowest part of the esophagus?

Answer 53

The cricopharyngeus muscle, which is at the level of C6 The cricopharyngeus muscle is also called the inferior pharyngeal constrictor. There are superior and middle pharyngeal constrictors that all work to push food down.

Question 54

Which is more associated with AOM, bulging or opacification of the TM?

Answer 54

Bulging Opacification can occur with effusion.

Question 55

Is age-related presbycusis conductive or sensorineural?

Answer 55

Sensorineural ("SENile = SENsorineural")